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J Wrist Surg 2022; 11(06): 501-508
DOI: 10.1055/s-0042-1743119
Scientific Article

Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion

Asgeir Amundsen
1   Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes, Norway
2   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
,
Marco Rizzo
3   Division of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Richard Berger
3   Division of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Frede Frihagen
1   Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes, Norway
2   Institute of Clinical Medicine, University of Oslo, Oslo, Norway
,
Steven L. Moran
4   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract

Purpose To evaluate the functional outcome and complications following primary ulnar head or total distal radial ulnar joint (DRUJ) arthroplasty in patients who have a partial or total wrist fusion.

Methods We conducted a retrospective review of 33 primary DRUJ implants in 31 patients who had a partial or total wrist fusion. Follow-up time averaged 67 months. There were 11 partial and 22 total wrist fusions with 22 ulnar head prosthesis and 11 total DRUJ implants. The mean age of the patients was 49 years. Eighty-one percent had previous surgeries with an average number of 4.6 previous wrist procedures. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion (ROM), and post-operative complications were noted.

Results The pain scores improved in 67% of the patients. The Mayo Wrist Score improved significantly from a mean of 39 preoperatively to 51 postoperatively. The grip strength and pro-supination remained stable. The wrist ROM also remained stable in the patients with partial wrist fusions. During the follow-up period, 10 (30%) of the DRUJ implants were explanted, with a trend toward higher explantation rates in total wrist fusions with one in the partial fusion group and nine in the total wrist fusion group. Four of the explantations happened in the first postoperative year. Nineteen (61%) of the patients required a second surgery for a DRUJ implant-related complication; this rate was similar between the partial and total fusion groups.

Conclusions DRUJ replacement resulted in improved pain scores and Mayo wrist scores in the majority of patients; however, the combination of primary DRUJ arthroplasty and total wrist fusion was associated with high complication rates. Surgeons should be aware of the high complication rate seen with DRUJ arthroplasty when combined with total wrist fusion.

Keywords

wrist - distal radioulnar joint - arthroplasty - wrist fusion - implant

Note

This work was performed at the Mayo Clinic, Rochester, Minnesota.




Publication History

Received: 13 April 2021

Accepted: 05 January 2022

Article published online:
23 February 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Nagy L, Büchler U. Long-term results of radioscapholunate fusion following fractures of the distal radius. J Hand Surg 1997; 22 (06) 705-710
    CrossrefPubMedGoogle Scholar
  • 2 Degeorge B, Montoya-Faivre D, Dap F, Dautel G, Coulet B, Chammas M. Radioscapholunate fusion for radiocarpal osteoarthritis: prognostic factors of clinical and radiographic outcomes. J Wrist Surg 2019; 8 (06) 456-462
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Bain GI, Ondimu P, Hallam P, Ashwood N. Radioscapholunate arthrodesis—a prospective study. Hand surgery: an international journal devoted to hand and upper limb surgery and related research. J Asia-Pacific Fed Soc Surg Hand 2009; 14 (2–3): 73-82
    PubMedGoogle Scholar
  • 4 Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26 (02) 221-228
    CrossrefPubMedGoogle Scholar
  • 5 Reigstad O, Holm-Glad T, Korslund J, Thorkildsen R, Røkkum M, Grimsgaard C. High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis. Bone Joint J 2019; 101B (07) 852-859
    CrossrefPubMedGoogle Scholar
  • 6 Toma CD, Machacek P, Bitzan P, Assadian O, Trieb K, Wanivenhaus A. Fusion of the wrist in rheumatoid arthritis: a clinical and functional evaluation of two surgical techniques. J Bone Joint Surg Br 2007; 89 (12) 1620-1626
    CrossrefPubMedGoogle Scholar
  • 7 Hayden RJ, Jebson PJL. Wrist arthrodesis. Hand Clin 2005; 21 (04) 631-640
    CrossrefPubMedGoogle Scholar
  • 8 Weiss APC, Hastings II H. Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application. J Hand Surg Am 1995; 20 (01) 50-56
    CrossrefPubMedGoogle Scholar
  • 9 Shaaban H, Giakas G, Bolton M. et al. The load-bearing characteristics of the forearm: pattern of axial and bending force transmitted through ulna and radius. J Hand Surg [Br] 2006; 31 (03) 274-279
    CrossrefPubMedGoogle Scholar
  • 10 Wimalawansa SM, Lopez RR, de Lucas FG. et al. Salvage of failed Achilles tendon interposition arthroplasty for DRUJ instability after ulnar head resection with Aptis prosthesis. Hand (N Y) 2017; 12 (05) 476-483
    CrossrefPubMedGoogle Scholar
  • 11 Papatheodorou L, Rubright J, Kokkalis Z, Sotereanos D. Resection interposition arthroplasty for failed distal ulna resections. J Wrist Surg 2013; 2 (01) 13-18
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Kakar S, Fox T, Wagner E, Berger R. Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis. J Hand Surg Eur Vol 2014; 39 (07) 739-744
    CrossrefPubMedGoogle Scholar
  • 13 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (02) 177-189
    CrossrefPubMedGoogle Scholar
  • 14 Lans J, Chen SH, Jupiter J, Scheker L. Distal radioulnar joint replacement in the scarred wrist. J Wrist Surg 2019; 8 (01) 55-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (09) 1639-1644
    CrossrefPubMedGoogle Scholar
  • 16 Savvidou C, Murphy E, Mailhot E, Jacob S, Scheker L. Semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2013; 2 (01) 41-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Adams BD, Leversedge FJ. Distal radioulnar joint. In: Wolfe SW. ed. Green's Operative Hand Surgery. 7th ed.. Philadelphia, PA: Elsevier; 2017: 479-515
    Google Scholar
  • 18 Faucher GK, Zimmerman RM, Zimmerman NB. Instability and arthritis of the distal radioulnar joint: a critical analysis review. JBJS Rev 2016; 4 (12) e3
    CrossrefPubMedGoogle Scholar
  • 19 Moulton LS, Giddins GEB. Distal radio-ulnar implant arthroplasty: a systematic review. J Hand Surg Eur Vol 2017; 42 (08) 827-838
    CrossrefPubMedGoogle Scholar
  • 20 Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev 2017; 1 (05) 191-196
    CrossrefPubMedGoogle Scholar
  • 21 Sauerbier M, Hahn ME, Berglund LJ, An KN, Berger RA. Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation. Arch Orthop Trauma Surg 2011; 131 (01) 15-26
    CrossrefPubMedGoogle Scholar
  • 22 Masaoka S, Longsworth SH, Werner FW, Short WH, Green JK. Biomechanical analysis of two ulnar head prostheses. J Hand Surg Am 2002; 27 (05) 845-853
    CrossrefPubMedGoogle Scholar
  • 23 Douglas KC, Parks BG, Tsai MA, Meals CG, Means Jr KR. The biomechanical stability of salvage procedures for distal radioulnar joint arthritis. J Hand Surg Am 2014; 39 (07) 1274-1279
    CrossrefPubMedGoogle Scholar
  • 24 Berger RA, Cooney III WP. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique. Hand Clin 2005; 21 (04) 603-620 , vii
    CrossrefPubMedGoogle Scholar
  • 25 Scheker LR, Martineau DW. Distal radioulnar joint constrained arthroplasty. Hand Clin 2013; 29 (01) 113-121
    CrossrefPubMedGoogle Scholar
  • 26 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
    PubMedGoogle Scholar
  • 27 Kakar S, Swann RP, Perry KI, Wood-Wentz CM, Shin AY, Moran SL. Functional and radiographic outcomes following distal ulna implant arthroplasty. J Hand Surg Am 2012; 37 (07) 1364-1371
    CrossrefPubMedGoogle Scholar
  • 28 Kachooei AR, Chase SM, Jupiter JB. Outcome assessment after Aptis distal radioulnar joint (DRUJ) implant arthroplasty. Arch Bone Jt Surg 2014; 2 (03) 180-184
    PubMedGoogle Scholar
  • 29 Adams BD, Gaffey JL. Non-constrained implant arthroplasty for the distal radioulnar joint. J Hand Surg Eur Vol 2017; 42 (04) 415-421
    CrossrefPubMedGoogle Scholar
  • 30 Axelsson P, Sollerman C, Kärrholm J. Ulnar head replacement: 21 cases; mean follow-up, 7.5 years. J Hand Surg Am 2015; 40 (09) 1731-1738
    CrossrefPubMedGoogle Scholar
  • 31 Ewald T, Skeete K, Moran S. Preliminary experience with a new total distal radioulnar joint replacement. J Wrist Surg 2012; 1 (01) 23-30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Baring TKA, Popat R, Abdelwahab A, Ferris B. Short-to mid-term results of ulna head replacement as both a primary and revision implant. J Clin Orthop Trauma 2016; 7 (04) 292-295
    CrossrefPubMedGoogle Scholar
  • 33 Rampazzo A, Gharb BB, Brock G, Scheker LR. Functional outcomes of the Aptis–Scheker distal radioulnar joint replacement in patients under 40 years old. J Hand Surg Am 2015; 40 (07) 1397-1403.e3
    CrossrefPubMedGoogle Scholar
  • 34 Sabo MT, Talwalkar S, Hayton M, Watts A, Trail IA, Stanley JK. Intermediate outcomes of ulnar head arthroplasty. J Hand Surg Am 2014; 39 (12) 2405-11.e1
    CrossrefPubMedGoogle Scholar
  • 35 Galvis EJ, Pessa J, Scheker LR. Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis. J Hand Surg Am 2014; 39 (09) 1699-1704
    CrossrefPubMedGoogle Scholar
  • 36 DeGeorge Jr BR, Berger RA, Shin AY. Constrained implant arthroplasty for distal radioulnar joint arthrosis: evaluation and management of soft tissue complications. J Hand Surg Am 2019; 44 (07) 614.e1-614.e9
    CrossrefPubMedGoogle Scholar
  • 37 Warwick D, Shyamalan G, Balabanidou E. Indications and early to mid-term results of ulnar head replacement. Ann R Coll Surg Engl 2013; 95 (06) 427-432
    CrossrefPubMedGoogle Scholar
  • 38 Herzberg G. Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?. Hand Clin 2010; 26 (04) 573-577
    CrossrefPubMedGoogle Scholar
  • 39 van Groningen JM, Schuurman AH. Treatment of post-traumatic degenerative changes of the radio-carpal and distal radio-ulnar joints by combining radius, scaphoid, and lunate (RSL) fusion with ulnar head replacement. Eur J Plast Surg 2011; 34 (06) 465-469
    CrossrefPubMedGoogle Scholar
  • 40 Berger RA. Implant arthroplasty for treatment of ulnar head resection-related instability. Hand Clin 2013; 29 (01) 103-111
    CrossrefPubMedGoogle Scholar
  • 41 Axelsson P, Sollerman C. Constrained implant arthroplasty as a secondary procedure at the distal radioulnar joint: early outcomes. J Hand Surg Am 2013; 38 (06) 1111-1118
    CrossrefPubMedGoogle Scholar
  • 42 Bennett K, Kamineni S. Aseptic loosening of an APTIS distal radioulnar joint arthroplasty—case report. Trauma Case Rep 2019; 21 (April): 100196
    CrossrefPubMedGoogle Scholar
  • 43 Bellevue KD, Thayer MK, Pouliot M, Huang JI, Hanel DP. Complications of semiconstrained distal radioulnar joint arthroplasty. J Hand Surg Am 2018; 43 (06) 566.e1-566.e9
    CrossrefPubMedGoogle Scholar
  • 44 Reissner L, Böttger K, Klein HJ, Calcagni M, Giesen T. Midterm results of semiconstrained distal radioulnar joint arthroplasty and analysis of complications. J Wrist Surg 2016; 5 (04) 290-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Schuurman AH, Teunis T. A new total distal radioulnar joint prosthesis: functional outcome. J Hand Surg Am 2010; 35 (10) 1614-1619
    CrossrefPubMedGoogle Scholar
  • 46 Laurentin-Pérez LA, Goodwin AN, Babb BA, Scheker LR. A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis. J Hand Surg Eur Vol 2008; 33 (01) 18-28
    CrossrefPubMedGoogle Scholar
  • 47 Bizimungu RS, Dodds SD. Objective outcomes following semi-constrained total distal radioulnar joint arthroplasty. J Wrist Surg 2013; 2 (04) 319-323
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Martínez Villén G, García Martínez B, Aso Vizán A. Total distal radioulnar joint prosthesis as salvage surgery in multioperated patients. Chir Main 2014; 33 (06) 390-395
    CrossrefPubMedGoogle Scholar
  • 49 Zimmerman RM, Jupiter JB. Outcomes of a self-constrained distal radioulnar joint arthroplasty: a case series of six patients. Hand (N Y) 2011; 6 (04) 460-465
    CrossrefPubMedGoogle Scholar